A 5-year-old boy was admitted to a rural New Zealand hospital with a 10-day history of abdominal pain. The pain was localised to the right iliac fossa (RIF) with guarding and examination revealed a palpable mass in the RIF. He had previously presented with a 1-day history of severe abdominal pain and fever and had been discharged the following day with a diagnosis of gastroenteritis. He was transferred to the tertiary hospital and a diagnosis was made on ultrasound scan of appendiceal mass with abscess. His condition was stable. He was commenced on conservative management and supportive care with intravenous antibiotics followed by a 2-week course of oral antibiotics. He responded well to conservative management and was scheduled for appendectomy after an interval of 6–8 weeks. You wonder whether it is necessary, now he is well, for him to have an appendectomy.

STRUCTURED CLINICAL QUESTION

In children who have had successful conservative management of appendiceal mass [population], does interval appendectomy [intervention] compared to watchful waiting [comparison] improve outcomes or cost effectiveness [outcome]?

SEARCH STRATEGY AND OUTCOME

TRIP database was searched with “interval appendectomy”: 1 cost-effectiveness analysis and 1 randomised controlled trial (RCT) were found.

Medline 1950–October 2007 was searched using the following keywords: interval appendectomy AND …